When Health Funds change their rules and/or premiums

The National Health Act 1953 defines a premium change as a change to the health fund rules. At present, a fund that proposes to change its rules (including premiums) is required to notify the Department of Health and Ageing at least 60 days before the proposed date of implementation.

The Minister does not approve rule changes as such, but rather, is empowered to disallow changes to rules where the Minister considers the proposed change could:

If the proposed change to rules are not disallowed, funds are required to tell their members, in writing, at least 7 days prior to the date of implementation about any change that;

On 11 September 2002 the Minister announced a new set of procedures for increasing private health insurance premiums - the first changes resulting from an Inter Departmental committee review of the rules and regulations governing private health insurance announced on 2 April 2002.

Under the new procedures, funds will continue to notify the Department of any intention to increase their health insurance premiums, however, when seeking an increase of less than the CPI benchmark, health funds “can expect a greater degree of certainty that the increase will not be disallowed by the Minister”.

Any fund seeking a premium rise larger than the CPI benchmark is required to provide the independent regulator, the Australian Prudential Regulation Authority (APRA), with detailed information justifying a larger increase.

Australian Prudential Regulation Authority

The Australian Prudential Regulation Authority is an independent Statutory Authority that regulates the health insurance industry (among other industries). APRA also collects and disseminates financial and statistical data regarding health funds. The Authority's website can be accessed at https://www.apra.gov.au/industries/private-health-insurance.

The Private Health Insurance Ombudsman (PHIO)

The Private Health Insurance Ombudsman is an independent body established to resolve complaints about a private health fund, a broker, a hospital, a medical practitioner, a dentist or other practitioners (as long as the complaint relates to private health insurance) and to be the umpire in dispute resolution at all levels within the private health insurance industry.

The Ombudsman's services are available to health fund members, hospitals, medical practitioners (including some dentists) as well as health funds. You can access the Ombudsman's website at https://www.ombudsman.gov.au/complaints/private-health-insurance-complaints.